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Darwin’s “gastric flatus”

When Charles Darwin died at age 73 on this day 133 years ago, his physicians decided that he had succumbed to “degeneration of the heart and greater vessels,” a disorder we now call “generalized arteriosclerosis.” Few would argue with this diagnosis, given Darwin’s failing memory, and his recurrent episodes of “swimming of the head,” “pain in the heart”, and “irregular pulse” during the decade or so before he died.

There is, however, considerable disagreement as to the cause of the “gastric flatus” that plagued him for nearly thirty years after his return to England from his voyage aboard the HMS Beagle. That mysterious illness consisted of repeated sudden attacks of abdominal pain, nausea, vomiting, and retching, two to three hours after eating. During the worst periods, he vomited after nearly every meal, sometimes for years on end. And yet, because he seldom regurgitated food, “only acid & morbid secretion,” his vomiting did not interfere with his intake or digestion of food, his general nutritional status, or for that matter, his scientific productivity. After creating psychological havoc for three decades, the gastric disorder faded and then disappeared as mysteriously as it had arisen.

Darwin’s physicians were totally nonplussed by his gastric complaints. When they could find no evidence of organic mischief, they assured him that eventually he would recover. They told him he had “suppressed gout,”  “an excess of gastric acid,” “inadequate amounts of gastric acid,” “mucous dyspepsia,”  “an allergic reaction,” or “over-breathing,” for which they plied him with a host of treatments, none of which produced any lasting relief.

Charles Darwin. Image Credit: J. Cameron, Public Domain via Wikimedia Commons.
Charles Darwin. J. Cameron, Public Domain via Wikimedia Commons.

Many of Darwin’s friends and later would-be diagnosticians thought he was a hypochondriac. However, hypochondriacs typically are reluctant to acknowledge the role of psychological factors in causing their symptoms; misinterpret benign physical sensations as evidence of serious illness; tend to respond to reassurance with anger rather than relief; and are frequently functionally impaired to a severe degree by the disorder. Darwin exhibited none of these characteristics.

It has also been suggested that Darwin’s gastric disorder was the result of an infection called Chagas disease, which he contracted while exploring in the Pampas of Argentina. Suffice it to say that the character and course of his intestinal disorder (not the least of which was its mysterious, spontaneous resolution after rampaging for 30 years) is inconsistent with published descriptions of Chagas disease.

In the final analysis, of the myriad diagnosis offered to explain Darwin’s strange illness, only cyclic vomiting syndrome has characteristics consistent with the full spectrum of the great man’s gastric disorder. The syndrome, though little known, is currently being diagnosed with surprising frequency. It consists of recurrent episodes of nausea, vomiting, and abdominal pain separated by asymptomatic periods. Migraine headaches and intense anxiety induced by the uncontrollable episodes of vomiting (both of which afflicted Darwin greatly) are common, as are cardiac arrhythmias and other neurological complaints (as, for example, numbness of the extremities and nervous tics, of which Darwin also complained).

If Darwin were alive today, he would be subjected to a host of examinations in an effort to diagnose his illness, all of which would likely prove to be negative. Having excluded all other diagnoses through such testing, the physician specializing in gastrointestinal disorders to whom Darwin would be referred, would eventually offer him a diagnosis of cyclic vomiting syndrome as reassurance that he was not alone in his suffering. Although that diagnosis has been consecrated by Rome III diagnostic criteria with its own symptom-based definition, it provides no insight into the disorder’s cause, the mechanisms by which it arises or is sustained, or an effective means of preventing or treating it. Like diagnoses such as irritable bowel syndrome, attention-deficit disorder, chronic hyperventilation syndrome, restless leg syndrome, sudden infant death syndrome, posttraumatic stress disorder, and many others given to patients today, cyclic vomiting syndrome does little more than paraphrase the complaints for which the patient seeks medical attention. Ultimately, it is no more enlightening or helpful in relieving the suffering of patients like Darwin than “excess gastric acid” or “suppressed gout” or “mucous dyspepsia” was over a century ago.

Feature Image: HMS Beagle. R. T. Pritchett, Public Domain via Wikimedia Commons.

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